This application is in response to RFA AA-01-004 "RESEARCH ON ALCOHOL AND AIDS," and proposes a four-year project to evaluate the efficacy of a HIV-risk reduction intervention that combines motivational-enhancement based treatment for alcohol problems with HIV counseling and testing. Our central premise is that people with alcohol use disorders (i.e., abuse and dependence), particularly those in inner-city communities with elevated HIV seroprevalence rates, are at heightened risk for infection with HIV and other STDs and benefit less from HIV-risk reduction interventions than other participants, and that theory-based clinic-delivered interventions targeting alcohol use and HIV risk behavior can be effective in reducing risk behavior in this population. We will randomly assign people recruited at an urban STD clinic to one of three time-matched conditions: (1) standard information-based pre-test counseling and HIV antibody testing, followed in two weeks by the test result and information-based post-test counseling; (2) client-centered theory-based pre-test counseling and HIV antibody testing, followed in two weeks by the test result notification and client-centered theory-based post-test counseling; or (3) client-centered, theory-based based pre-test counseling and HIV antibody testing, followed in two weeks by test result notification and post-test counseling (as implemented in Condition 2) and a 45-minute alcohol use disorder intervention based on motivational interviewing principles. We will assess participants' sexual and substance use behavior at baseline, post-intervention, and in 3-, 6-, 9-, and 12-month follow-up interviews. We will test the hypothesis that participants in the HIV counseling and testing intervention (HIV-CT) plus alcohol treatment condition will exhibit greater sexual risk behavior reduction and maintain these reductions longer than participants in either of the other conditions. We will also examine whether the alcohol treatment in this setting leads to reductions in alcohol use and whether theory-based HIV-CT alone led to greater risk behavior reduction than the information-based HIV-CT. In addition, the design of the proposed study will provide data with which to examine theory-based variables that may mediate intervention outcomes, factors involved in maintenance of risk behavior reduction, and the association of alcohol use with sexual risk behavior. Combining these interventions for HIV risk reduction and alcohol use problems at STD clinics and other HIV testing sites may result in an efficient HIV-prevention intervention package with enhanced effectiveness that is feasible in real-world settings and has the potential to be used with many people each year. Findings derived from the study can also guide future efforts to develop combined alcohol/HIV interventions for groups at risk for HIV infection and the use of brief motivational interventions for alcohol problems among non-treatment seeking problem drinkers.